Caries or tooth decay is the most common infectious disease in the world. An estimated 95% of the world's population suffers from it. The old folk name is tooth wolf.
Caries is a demineralization process of the tooth tissue: tooth enamel, dentin (= dental bone) and root cement. Demineralisation is initiated by acids that are secreted by certain bacteria, converted from sugars. Examples of bacteria that cause caries are mainly Streptococcus Mutans and Lactobacillus. The pH falls due to the secretion of acids by these bacteria. The acid increases the solubility of the calcium hydroxyapatite (the mineral that makes up the enamel) and will dissolve. This creates a cavity. Acid from food, which directly causes demineralization of teeth and molars, is not seen as caries, but as erosion of the teeth. The bacteria that cause caries are found everywhere in the mouth. Everyone has these bacteria in their mouth, to a greater or lesser extent. These bacteria causing caries are located in dental plaque. The bacteria can cause caries from this dental plaque.
The dental plaque contains:
- The bacteria and, among other things, the acids they excrete.
- Substances, mainly proteins, from the saliva.
- Residues from food and drink.
- Dissolved minerals from that part of the tooth that is dissolved, from toothpaste, saliva, etc.
If the plaque remains on the tooth surface for a longer period of time, the patient's defense is not optimal, etc., then caries will affect the teeth and molars. Dentists therefore recommend flossing well with dental floss (or using a toothpick or tooth carrier) after eating to remove as much of this plaque as possible.
The damage to the tooth or molar is usually seen in the first phase of caries as a white dull spot (lesion) on the enamel, which may discolor as time passes. Up to this point the tooth can still recover by remineralization. A lesion (starting hole) that recovers can be recognized by the presence of the discoloration (white or brown) and by the hard and shiny surface of this spot of discoloration. When the caries process continues, the enamel will be weakened to such an extent that the enamel crumbles and a cavity is created. This creates a cavity (hole) through which the bacteria gain access to the dentin. The dentine consists partly of organic material that can be directly consumed by the bacteria and this causes the tooth to rot. The teeth have a defense mechanism (by closing the dentine canals), but with long and frequent acid attacks (due to high frequency of sugar consumption) this is insufficient. The caries can continue up to the dental nerve. This will irritate the dental nerve, whether or not accompanied by a toothache.
That is why we think the half-yearly audit is so important to be able to intervene at an early stage, where necessary. In the case of inadequate oral hygiene, it may sometimes be necessary to go to a prevention assistant to improve your brushing method with her.
The so-called "bitewings" are a useful tool for the early diagnosis of caries. These are X-rays on which you have to bite. On this you can see both below and above choosing on both sides of your teeth. An early stage of caries can be found on this so that the filling can remain small. This would usually be missed without the photo.
It goes without saying that within our practice we only fill with so-called white fillings, the composites. In dentistry, composite is a filling material that consists of a matrix phase and a filler phase. In practice, it is a filling material with a matrix of synthetic resin, a binder and an inorganic filler such as quartz, glass, and the like. The filler gives the filling material its firmness, the synthetic resin ensures good processability of the material and the binder (silane) adheres the fabrics well together.
In contrast to amalgam, which is retained by retention, composites are glued to the tooth material after etching the tooth with mostly phosphoric acid (35% -50%) or another acid and applying a primer and bonding. Composite is available as chemically hardening and as light hardening. A combination of these is also possible: these are the so-called dual-cure composites. The polymerization process is initiated chemically or by light (photopolymerization). With chemically hardening composite, two pastes are often mixed; light-hardening composite hardens because the substance splits camphorquinone into radicals that initiate the polymerization process. Because composite is not free from shrinkage, it is very important to minimize shrinkage as much as possible. The dentist can do this by not filling the cavity in one go, especially if it is large. By applying the composite in layers, the total shrinkage can be compensated and it is also certain that all material is cured. The maximum thickness that is used for most curing lamps is approximately 3 mm. The occurrence of the so-called "white fill sensitivity" can thus very likely be prevented or kept to a minimum.
The quality of our "white filling" has become so good over the years that it can be seen as a fully-fledged alternative to the old amalgam filling.